The patient was taken to the operating room for arterial bypass to the left internal carotid circulation. The position of the patient is shown, with the head in radiolucent tongs for the intraoperative angiogram and the left arm free for radial artery harvest. The patient is positioned supine with a shoulder roll beneath his left shoulder and his head rotated to the right approximately 45 degrees. The neck is extended slightly to allow gravity to retract the frontal lobe away from the skull base. The patient's groin (not shown) is also prepped and a femoral artery sheath is placed for the intraoperative angiogram.
The patient was wired to monitor somatosensory evoked potentials from the ulnar and posterior tibial nerves bilaterally, and EEG. The evoked potentials evidence decreased amplitude and latency if there is cerebral ischemia. The EEG also measures burst suppression during the clipping of the cerebral arteries during the distal anastomosis.
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